Diagnostic information systems

ABSTRACT

Relevant clinician determined diagnostic and marker information forming a patients profile are fed into a computer system containing comparative profiles. The comparative results are reported to the clinician as are recommendations for treatment and further investigation if desired. A final diagnosis is reported and treatment, if utilized, is fed back to enhance the computerized profiles.

CROSS REFERENCE TO RELATED APPLICATIONS

This is a completed specification of the Invention disclosed inProvisional Application Ser. No. 60/343,333 filed Dec. 28, 2001, thebenefit of the filing date of which is claimed.

BACKGROUND OF THE INVENTION

Diagnostic methods of diseases and other malady detention by aclinician, i.e. a physician or others under the physician's directionand control, rely on the identification and evaluation of quantifablemarkers, and other information. Markers include such things as riskfactors, indicators based on family history, demographics andenvironmental conditions, quantifiable signs and symptoms, and analytesfound in biological fluids, such as blood. Currently, the diagnosis of adive or other malady relies upon the subjective analysis of markerscollected by a clinician. Unfortunately, this subjective analysisprocess most often cannot review and evaluate all the critical andrelevant actors and give appropriate level of weighting in order toreach an accurate and timely diagnosis.

While the collective knowledge base of diagnostic information is vast,and the medical profession still relies heavily on yesterday'stechnology of organizing and providing the medical profession withinformation primarily through publications. In diagnosing a patient'shealth or disease state, the physician is largely relegated to searchingthe literature, consulting specialists, and relying on personalknowledge and experience.

The current and growing trend in disease diagnosis is to utilizeinformation based on an exchange between patients and computers. Itlacks, in good part, the control of the medical professional.

U.S. Pat. No. 6,196,970 to Brown discloses a method whereby data iscollected from a plurality of research subjects and used to update aresearch protocol. While a medical research expert is used to determineany changes to the protocol, the information provided is controlled bythe research subject and therefore limited by the accuracy of thesubject's answers. No requirement is made of the subject's health orlack thereof.

U.S. Pat. No. 6,270,456 to Iliff pertains to a system and method wherebythe patient imparts information to a computer using a list contained inthe computer or using existing computer based diagnostic scripts. Thecomputer controls the information and is limited by information input bythe patient. Responses to questions are analyzed and converted intosymptoms which are compared to symptoms on file. This system is limitedby the computer and the patient.

U.S. Pat. No. 6,247,004 to Moukbeibir against which there was cited some34 patents and 10 publications, is directed to a computer system thatdetermines possible events of a large number of medical conditions orevents. A master search form is created as well as master maps.Providing access to displays of conditions or events is apatient/computer controlled system.

U.S. Pat. No. 6,063,026 to Schauss et al discloses a method andapparatus for use as a medical diagnostic system. It provides a firstdatabase containing disease indicators including human experience testresults associated with the indicators. There is also provided a seconddatabase containing a plurality of drugs and the indicators associatedwith each drugs. Test results are input for an individual includingspecific diagnostic levels and comparing said specific levels of theindividual with the indicator data in the database. The indicatorpresence levels are determined with preset specific levels associatedwith the individual. This information is compared to the indicatorpresence information contained in the second database to provide adetention of effects of the drugs in the individual.

U.S. Pat. No. 6,248,063 to Barnhill et al relates to an apparatus andprocess for diagnosing, screening or prognosticating diseases. Inparticular, data is obtained from a patient; the data is digitized;selecting which of the data are associated with a disease; scalingdigitized values; performing tests to analyze the disseminating power ofthe data. Then using a trained computer to produce an output which maydetermine whether the patient has or is likely to have the disease.

U.S. Pat. No. 6,120,440 issued to Goknar discloses a computer controlledsystem for psychometric analysis and diagnosis based on a patient'sreply to a series of questions. It is limited by the program and patientreplies although at least one other patient is looked to for acomparison.

U.S. Pat. No. 6,053,866 to McLeod relates to a method of computerizedpsychiatric analysis based on patient answers to questions to establisha preliminary disorder identification which after analysis may suggestfurther questions to determine if additional disorders may exist.

U.S. Pat. No. 5,784,539 to Lenz is of interest and describes a computersystem which may be applied to store and analyze medical data.

U.S. Pat. No. 5,935,060 to Iliff discloses to a system and method usedby a patient and a computer to assess the existence or probability of adisease. In particular, the computer interviews the patient for aspecific medical condition to then provide as an output a diagnosis.Again, it is a patient/computer controlled diagnosis for a condition.

Despite advances, according to the findings of a 2000 report, To Err isHuman: Building a Safer Health Care System, by the Institute ofMedicine, the medical arm of the National Academy of Sciences, anestimated 44,000+ Americans alone die each year as a result of medicalerrors, with an estimated cost between $17 billion and $29 billion, andas many as 98,000 Americans die each year from adverse medical events.Medication errors alone are estimated to account for over 7,000 deathsannually.

As published in The New England Journal of Medicine, Vol 330:1792(1994),the current computer-based diagnostic systems provide correct diagnosesopinions 52% to 71% of the time. Their conclusions were that the currentsystems should only be used by physicians who can identify and use therelevant information and ignore irrelevant information that was producedby existing systems.

SUMMARY OF THE INVENTION

The present invention discloses an improved medical diagnostic systemand computer means to its utilization that allows for analysis ofavailable markers and other critically relevant indicia, providesdirection in selecting additional markers and indicia for analysis,creates a profile for the patient being diagnosed, and compares thisprofile against known profiles for diseases and other medicalconditions. Once potential diagnoses are found, the system presents aweighted list for a clinician to review and rule-in and rule-out testsor a need for markers to aid the clinician in reaching a final, accuratediagnosis, which can be explained to receive recommendations fortreatment.

More particularly, the present invention relates a method and apparatusfor a data system to receive quantitative diagnostic information andanalyze the same to aid physicians in the diagnosis of disease or othermaladies. It comprises: means to collect diagnostic information (data)on an ongoing basis provided by physicians and related medicalspecialists; filing the diagnostic information collected; comparing thecollected information to input diagnostic information of a patient todetermine potential diagnosis; reporting the same to the subscribingclinician with, if necessary, requests for additional input to refinethe diagnosis and suggestion for treatment based on information storedand received. The database is refined based on confirmed diagnosticpatterns submitted. Analyzing and storing input diagnostic informationmay be in graphical from to fingerprint a potential disease state and indeveloping an output form which is an automatic translation ofdiagnostic data in standard analysis format to define the disease stateor what information is required to confirm a diagnosis by an iterativeinput and output. A diagnosis, if confirmed, and is used to treat thepatient, is fed back to the system to expand its database refine itsability to provide an accurate data analysis and further diagnosis.

Patient data can be input from any location via the Internet or thelike. It may be translated into standard graphical format; compared withdatabase information on the patient, and possible diagnoses based ondata are listed. The diagnostic choice is narrowed by suggestingadditional diagnostic testing using a process of elimination andconfirmation. A report of suggested diagnosis is generated withbackground information and other possible conformatory symptomsidentified. The database may be updated with confirmatory informationthrough inviting the physician for a final data input. The physician maybe provided client database history of his patients.

THE DRAWINGS

FIG. 1 is a block diagram illustrating the DIS overall flow ofinformation according to the invention.

FIG. 2 is a block diagram illustrating the particular logic flow ofpatient diagnostic information use for the patient by subscribingclinicians.

FIG. 3A is a graphic illustration of established ranges for given bloodor other sera components.

FIG. 3B is a graphic illustration of analysis of the constituents of anindividual's sera (blood) relative to FIG. 3A to establish divergencefrom acceptable ranges.

DETAILED DESCRIPTION

The Diagnostic Information System (DIS) of this invention providesclinicians (physicians and others in their control) information whichaids in the diagnosis and treatment of diseases and other medicalconditions. It comprises:

-   -   a) feeding to a living databank or database containing normal        and abnormal diagnostic profiles a patients diagnostic profile,    -   b) comparing the patients diagnostic profile to relevant        diagnostic profiles contained in the databank,    -   c) computing and delivering from the comparison a weighted list        of potential diagnoses and treatments and recommendations for        further rule-in/rule-out testing and marker requests to finalize        diagnosis and treatment. The list of potential diagnoses is        refined based on rule-in/rule-out tests and markers identified.

If the most probable diagnosis is confirmed by patient treatment, theconfirmed information is added to the databank. Incorrect diagnosticinformation may also be added to aid in refining the indicia used infuture analysis.

Data utilized and delivered may be transmitted through any formatincluding the Internet. Data may be converted from digital to graphicalfor pattern comparison and missing data can be added for diagnosticpattern verification. In any event the fed indicia from verifieddiagnosis may be used to increase the size of or improve the databank.To this end, a gateway system may be and is preferably used to qualifyindicia for entry into the living databank to maintain its integrity asa viable means for accurate diagnosis.

Definitions—As used herein and the claims the following have the statedmeanings

-   -   a) Living Databank or Database—a data receptive bank or base        having the characteristics of a living organism capable of        digesting new information and growing in utility by adapting to        both the advances of science and technology in the disciplines        applied in diagnosis    -   b) Gating—a program for accepting only confirmed information        relevant to a diagnosis in question to sustain the system's        integrity    -   c) Rule-in/Rule-out—a yes/no evaluation of a bit of information        in determining its relevance to a diagnosis under consideration    -   d) Weighted Diagnosis—of possible diagnoses reported as output,        the relative probabilities of each to be the most likely    -   e) Clinician—physicians and/or medical professionals operating        under their direction and control of the physician

The invention pertains to a marriage of the disciplines of medicalscience, clinical diagnostics and computer science while accommodatingthe exponentially increasing knowledge in these disciplines.

The diagnostic information is from any of a variety of sources. Thesources include quantitative analysis of body fluids such as blood,saliva, and urine as well as quantitative and qualitative informationobtained from x-rays, spinal taps, MRI, cat scans, ultrasound, biopsies,and the like. Every bit of relevant and critical information may be usedin determining an analysis of possible diagnosis to be modified, ifrequired or at all, in reporting probable diagnosis to the clinician aswell as inputs desired to confirm or reject a diagnosis.

The general flow of developed information is shown in FIGS. 1 and 2 anda comparison of measured analyte concentrations as compared to standardconcentrations in blood is shown in FIGS. 3A and 3B.

With reference now to FIGS. 1 and 2 developed information is input to beused to enhance the database and update patient information and form thebasis for a patient profile which is compared to the profiles forsimilarity and possible matches contained in the databank. This resultsin an output of possible diagnoses, treatments and requests which theclinician uses to select and perform identified clinical tests an/orprovide relevant marker information. This information is fed to thecomputer which establishes a diagnosis probabilities which is reportedto and utilized by the clinician in treating the patient. Thisinformation is also used to enhance and update the patients medicalrecord and modify the databank based on an evaluation of success orfailure of suggested diagnosis and treatment based on data fed to andcompared to data contained in the databank.

As indicated the present invention is directed to physician controlledexchange of diagnostic information to aid the physician in forming anopinion about a disease state and how to treat it. FIG. 1 displays ageneralized block diagram for the flow of information, FIG. 2 is a morespecific block diagram As to each, the initial input is the existingmedian and recognized parameters of measurable components as shown inFIG. 3A for sera (blood) and other indicia. The comparison is used todetermine the possibility of a disease and means to treat it.

In particular FIGS. 3A and B illustrate test results obtained from apatient against standardized analysis. There is shown in FIG. 3A thelimits and median of the known information to date.

FIG. 3B depicts the results of an individual's test to establish thedeviance from the standard shown in FIG. 3A.

The objective is to find by proposed treatment an input of data toreshape FIG. 3B to FIG. 3A or compress or expand the ranges shown inFIG. 3A standard to be after integrate the patient's information toconfirm, reject, or better analyze the existence or possibility of adisease or other malady.

It is controlled by physicians or those under their direction andcontrol and designed to be released to participating physicians or thoseunder their addition and control. As indicated, the procedure of thisinvention is physician controlled. It may be direct control or through acontrolled person such as another, nurse, pharmacist, clinician or thelike.

With reference again to FIGS. 1 and 2 there is shown the flow ofinformation in and out of the database. The database is fed byphysicians (P1, P2 etc) or those under their direction and control.

Data received is compared to established sera ranges such as shown inFIG. 3A with normal limits (H for high, L for low) of acceptability.FIG. 3A also shows an established median (N).

The physician, given a patient's chemistry profile, e.g. FIG. 3B, usesmeasures to bring the patient within the limits of FIG. 3A. The measurestaken if utilized to success may be input into the database to confirmor refine information contained in the database.

This information is used to report the effects of treatment toparticipating physicians who have confirmed a deviation from establishedlimits using gathered information and existing ranges. The collectedinformation is used to change the database based on confirmed diagnosticpatterns; fingerprint a disease state and develop translatable input andoutput forms which are an automatic translation of input data into aaccepted diagnosis format whether digital or graphical.

For example, a patient exhibiting chest pains may cause the clinician toinitially conclude the possibility of a heart attack, indigestion,stroke or like possibilities. By feeding developed information to thesystem such as panel results and other relevant information, the systemwill provide an initial range of possibilities and means to remedy thecondition. Additional tests and other information are supplied to theclinician. By an interactive exchange between the clinician and thesystem, the most likely diagnosis can be arrived at. The system willpropose, based on information received, the probable treatments to beadministered. If the treatments are worthwhile, such information may beadded to refine the databank. If negative, it may also be added torefine the databank.

The system is clinician/computer controlled and can respond to datainput as fast as the computer contained information will allow. No bitof information is irrelevant or to be ignored. If confirmed to havediagnostic value it can be input or stored in the databank for fixtureuse.

While receiving information in digital format, the system convert tographical format and produce an output in graphical and/or digitalformat. Either can instruct the clinician as to information desired orneeded for a final diagnosis. It will provide an initial means oftreatment and by an exchange of information to and from the clinician afinal report of the diagnosis and method of its treatment. Because theiterative exchange of information is computer controlled the speed ofresults is limited only by time, that is the time required to feedinformation, amend information and report to the clinician results as ofdate. How the clinician provides and receives data is controlled by theclinician independent of analysis and recommendations reported. Thereality is that by exchange of information the most likely diagnosis andits treatment can be defined.

Besides patients, these to be benefited are other physicians, drugmanufacturers and insurers who assess the cost of medical treatment forindividuals.

Patient data can be input from any location via the Internet or thelike. It is automatically translated into sand digital or as desired,graphical format; compared with database information and a possiblediagnosis based on input data is listed. The diagnostic choice isnarrowed by suggested additional diagnostic testing using a process ofelimintion and confirmation. A report of suggested diagnosis isgenerated with background information and other possible confirmatorysymptoms identified. The database is updated with confirmatoryinformation through inviting the physician for a final data input. Thephysician may provide and may be provided client database history of hispatients.

The types of analysis used include evaluation of all measurablesubstance in the fluids such as urine and blood ranging from Fa to Fn onFIGS. 3A and 3B to more specific markers, as for instance, diabetesfactors, arthritic factors and the like.

In all instances, the clinician is in control and for cooperation may beallowed to obtain outputs for his patients as consideration for patientinputs to the database. The basic data and patient data may be developedusing known standard chemicals or procedures as described for instancein Clinical Chemistry Journal Supplement, Effect of Disease on ClinicalLaboratory Tests, Clin Chem, Vol 26(4), 1980; Current Diagnosis/Conn's7^(th) ed, French's Index of Differential Diagnosis, 12^(th) ed, Manualof Emergency Medicine, Manson's Textbook of Tropical Diseases, Conn'sCurrent Therapy 3^(rd) ed., Clinical Decision Levels for Lab Test,1^(st) ed., Internal Medicine Textbook, 2^(nd) ed., The Merck Manual,17^(th) ed., Current Diagnosis, 9^(th) ed., each incorporated byreference.

The type of the diagnostic information system of this invention greatlyimproves the percentage of correct diagnoses based on utilization ofprofiles based on real cases which are updated as new findings occur,providing a broad base of diagnostic information for use in forming andexpanding the diagnostic profiles. Safe guards may be and preferably arebuilt into the system throughout to alert physicians of potentialerrors.

In addition to a reduction in diagnosis which in itself, can save livesand reduce the costs associated with lost lives, the diagnosticinformation system of this invention can reduce the overall cost ofhealthcare by reducing the time to accurate diagnosis.

Diagnostic methods used to identify medical conditions rely on theidentification and utilization of quantifiable markers provided byclinicians. Such markers also include subjective markers such asphysical symptoms, family histories, x-ray, MRI data and the like. Wherethis type of data does not readily lend itself to computer application,their use is a must a their value in diagnostics is undeniable. Thissystem can translate such “soft” data into hard numeric data forcomputer application and ultimately to graphical information as desired.

The system of this invention provides physicians with data to aid in thediagnosis and treatment of disease and other medical conditions.Flowcharts of the system are illustrated in FIGS. 1 and 2. The method bywhich it operates is to:

-   -   1. collect qualified diagnostic information on an on-going basis        from participating clinicians and adding such information to        modify existing diagnostic profiles;    -   2. compare a patient's diagnostic profile against disease and        other medical condition profiles stored in the system's        database;    -   3. compute a weighted list of profile diagnoses and treatments        with further rule-in/rule-out testing/marker recommendations;    -   4. refine the list of potential diagnoses based on input of        suggested rule-in/rule-out testing/marker information; and    -   5. allow diagnostic profiles to be confirmed and added to the        databank.

The diagnostic information system contains many highly innovativeaspects. They may include:

-   -   a) the ability to convert digital data into a graphical pattern        for diagnostic comparison;    -   b) identification and listing of missing data for pattern        completion or verification; and    -   c) means to increase the size of the databank by using verified        diagnostic patterns added to the databank.

In addition, the system preferably includes means to create a softwaregating system to qualify information obtained for inclusion in thedatabank. This method of qualification keeps the integrity of the“living database” viable for accurate diagnosis on an on-going basis.

In addition to receiving test data, the system may, as required, suggestadditional diagnostic information needed to increase the probability ofan accurate diagnosis. The additional information is to either rule-inor rule-out the most probable diagnoses. Probability factors aregenerated by recent databank entries, history and demographics ofpatient, initial test that entered into the system by the clinician, andother relevant information. Also, the probability of a rapid, accuratediagnosis is greatly increased by the living databank. As the databankgrows, in real time, the clinician will be able to see trends andincreased likelihood of diseases or other medical conditions based onmarkers such as demographics, such as age, geographical location, familyhistory, genetic predisposition and the like.

The accuracy of the diagnosis is enhanced by the gating system whichmaintains the integrity of the databank. Diagnoses requires confirmationbased on successful treatment and other proven methods of verificationprior to incorporation into the system databank.

Significant elements of the system include digital translation ofqualitative data; an auto feedback gating software that is able toaccept only confirmed diagnosed cases or information and acts to marrythe disciplines of medical science, clinical diagnostics and computerscience; and accommodates the exponentially increasing knowledge base inthese disciplines.

The minimum results from the practice of the invention are betterenabling computer assisted diagnosis, reduce the time required fordiagnosis, reduce the cost of diagnosis, and increase the accuracy ofdiagnosis.

This creates a quantum leap in transforming the current “art” ofdiagnostics into more of a scientific discipline and one that is lessdependent on the qualitative soft data interpretation and limited by theindividual knowledge base of the clinician, and is more based on thecollective knowledge base of the medical community. It augments thephysician's curt database and greatly expands it. It may employ a voicesignature “squawk box” used in the physicians examining room andelectronic pens/pads connected to a computer system that is able to takethe physician's observations, issue laboratory orders, process testresults and provide the physicians with the patient's medical records,diagnosis, suggests available therapy and logic for arriving at theresults and suggested course of action presented. The knowledge baseincrease in the scientific disciplines is utilized to expand thedatabase and increase the sophistication of data usage, as well ascomputations employed. Therefore the convenience and accuracy ofdiagnosis, medical record keeping and the effectiveness of therapeuticprocesses are in the living database continuously enhanced.

Perhaps the greatest value of this system is to increase the scientificknowledge base in the field of medical diagnostics and to keep onincreasing this knowledge base continuously in the future and make itreadily available to the medical disciplines to reduce human suffering.But even as important is that it provides the medical communities ofphysicians instant access to a database that previously took long hours,days or weeks to research. In addition the system databank is based onconfirmed diagnosed cases, not theories or conjectures. Because of this,complete information becomes available to all clinicians not just a fewwho can or will spend the needed research time to follow up cases.

The following illustrates the practice of this invention.

EXAMPLE

A patient presents himself to his clinician. He is an African-Americanin his mid-30s. He has had a sore throat for more than 24 hours. Theclinician collects relevant data for entry into the diagnosticinformation system: sore throat, pulse rate 120 beats per minute, bloodpressure 115/75, audible respiration, trouble with swallowing, fever(102 degrees F.), non-smoker, moderate drinker, no medications, noallergies.

Computer returns possible diagnoses:

-   -   Retropharyngeal or peri-tonsillar infections    -   Infectious mononucleosis    -   Diphtheria    -   Ludwig's angina    -   Epiglottitis    -   Allergic drug reactions    -   Foreign bodies    -   Tumors or trauma to the larynx    -   Inhalation or aspiration of toxic chemicals

Physician selects epiglottitis. The computer recommends neck and chestexamination and a CT scan for rule-in/rule-out refinement. Physicianperforms the tests and enters data into the computer system. The CTdisplays thickening of epiglottitis, aryepiglottic folds false and truevocal cords. Chest examination is unremarkable, except for transmittedsounds. Aside from the marked sinus tachycardia, the cardiovascularexamination is normal. Additionally, anterior tenderness in the neck isfound.

The computer returns epiglottitis as the diagnosis and recommendedtreatment is listed as intubation as needed and antibiotic treatment.Typically, second or third generation cephalosporins are used.

Physician provides treatment to the patient. Treatment is successful.Physician updates the profile with successful treatment. The profile isadded to the patients profile and the system database.

1. A method for computerized determination of an abnormal medicalcondition in a human patient which comprises: a) inputting, to a livingdatabank containing a plurality of diagnostic profiles of normal andabnormal medical conditions, a diagnostic profile of at least onepatient as supplied by at least one clinician; b) comparing the inputpatient diagnostic profile to the diagnostic profiles contained in theliving databank; c) computing and reporting to the clinician based onthe comparison a weighted list of possible abnormal medical conditionsand means of treatment and, in order, suggestions for further diagnostictests and markers; d) further computing and reporting, on an iterativebasis, and based on all clinician responses to suggested furtherdiagnostic tests and markers a refined possible diagnosis and treatment;e) continuously refining the diagnostic living databank utilizingclinician input of confirmed diagnosis and treatment.
 2. A method asclaimed in claim 1 in which abnormal diagnosis or treatment are input tothe living databank to refine the diagnostic profiles contained in theliving databank.
 3. A method as claimed in claim 1 in which inputinformation is processed by a gating program to accept only informationconfirmed and relevant to the diagnosis in question.
 4. A method asclaimed in claim 1 in which input digital data for a patient isconverted to graphical format at least for the purposes of thecomparison.
 5. A method as claimed in claim 1 in which any output ispresented in formats selected from verbal, written, digital, graphicaland a combination thereof.
 6. A method as claimed in claim 4 in whichany output is presented in formats selected from verbal, written,digital, graphical and mixtures thereof.
 7. A method as claimed in claim1 in which the patient profile and other relevant information are inputfrom remote sources.
 8. A method as claimed in claim 1 in which thecomputed results are transmitted to a remote receiver.
 9. A method asclaimed in claim 7 in which the computed results are transmitted to aremote receiver.
 10. A method as claimed in claim 1 which inputs arereceived from multiple clinicians and reports are made to multipleclinicians.
 11. A method as claimed in claim 10 in which the computedresults are transmitted to at least a remote receiver.
 12. A method forcomputerized determination of an abnormal medical condition in a humanpatient which comprises: a) inputting, to a living databank containing aplurality of gated diagnostic profiles of normal and abnormal medicalconditions, a gated diagnostic profile of at least one patient assupplied by at least one clinician; b) comparing the gated input patientdiagnostic profile to the relevant diagnostic profiles contained in theliving databank; c) determining on a rule in/rule out basis a weightedlist of possible abnormal medical conditions and means of treatment andrequests for further diagnostic rule in/rule out tests and markers; d)further computing on gated basis and reporting, on an iterative basis,and based on all clinician responses to suggested further diagnostictests and markers a refined possible diagnosis and treatment; e)refining the diagnostic living databank utilizing clinician input ofconfirmed diagnosis and treatment.
 13. A method as claimed in claim 12in which abnormal diagnosis or treatment are input to the livingdatabank to refine the diagnostic profiles of the living databank.
 14. Amethod as claimed in claim 12 in which input digital data for a patientis converted to graphical format at least for the purposes of thecomparison.
 15. A method as claimed in claim 14 in which any output ispresented in formats selected from verbal, written, digital, graphicaland combinations thereof.
 16. A computer system for diagnosis ofdiseases and other human maladies which comprise: a) living databankprogrammed to receive and retain on an ongoing basis clinical diagnosticand marker information input by a clinician; b) means to form from inputdiagnostic information profiles of normal and abnormal medicalconditions; c) means to receive diagnostic and marker information toform a profile of the patient; d) means to compare the formed profile ofthe patient to contained normal and abnormal profiles; e) means tocompute a weighted average of possible diagnosis and treatments anddetermine needs for fir diagnostic tests and markers; f) means to reportto the clinician the results of the computed weighted average; g) meansto receive and respond to responses from clinicians of further clinicaltest and markers to refine the diagnosis and methods for treatment; andh) means to update the living databank from feedback on the results ofstep (g).
 17. A computer system as claimed in clan 16 which is adaptedto receive diagnostic and marker information from a remote transmissionmeans and deliver responses and requests to the remote receiver.
 18. Acomputer system as claimed in claim 16 including gating means to retireinformation supplied to the databank to receive or reject informationrelevant to the databank.
 19. A computer system as claimed in claim 16including means to receive and transmit information by means selectedfrom the group consisting of oral, digital, graphical sad combinationsthereof.
 20. A computer system as claimed in claim 16 which includesmeans to cornet received information to graphical format and transmitinformation in graphical and digital format.